Harm Reduction: Because a Dead Addict Can’t Recover

Who among us has not been affected by addiction? Whether it be someone you know, a family member, or perhaps even yourself, most of us have had to deal with addiction at some level. Addiction is one of those diseases, like cancer or diabetes, that sneaks up on you, creeping in little by little, until one sad day you realize you are afflicted. If we could only see it coming, wouldn’t we do something to stop it? Of course, we would! But, this disease is so insidious, we just don’t begin to fight it until it starts to take us down – if even then. No one wakes up one morning, looks at their calendar, and decides, “Today is the day I become an addict.”

I write this column because, like many of you, I have been hurt by drug addiction. There was a time I couldn’t have imagined myself speaking out in favor of what is known as “harm reduction” (giving people clean needles to prevent hepatitis B and C and HIV infection, giving naloxone to reverse overdoses, etc.) in a public forum like this, but here we are.

The manipulation and dishonesty that accompany addiction can make feelings of resentment and anger surge, twisting a person’s heart, and bringing out their deepest desire for revenge. But, forgiveness is a better salve – anger saps our energy and ultimately does us no good. One might feel that dying of an overdose is deserved by those who continue to take drugs, despite knowing they are bad for them. However, addiction, by its very nature, is a disease in which the brain fully comprehends that taking drugs is not good, but the overwhelming compulsion to do so is just that – an overwhelming compulsion over which one has little control, except in the best of times with treatment.

Today, we use “harm reduction” for all sorts of health issues – like giving medications for high cholesterol and diabetes for the person who doesn’t (or can’t or won’t) improve their diet and exercise, seat belts to prevent injury or death, and many other situations. So, why not use it for people with substance use disorders? Studies have shown that substance users who have the support of harm reduction agencies are more likely to go into recovery, and that’s ultimately what we want, isn’t it? Like the brash sub-headline of this column says: a dead addict can’t recover!

Addiction comes in many forms – my drug of choice is sugar. Some people gamble; others take heroin or other opioids (narcotics) like fentanyl, oxycodone and/or morphine. In fact, we are currently in the midst of an opioid epidemic. Back in the 1990s, the concept that pain was being insufficiently treated by health care providers got prescribers thinking of pain as the “5th vital sign,” in addition to temperature, pulse, respirations and blood pressure. This thinking spiraled into more prescribing of opioids, which are highly addictive. The numbers of people dying from overdoses has skyrocketed. Recently, the price of heroin has declined and is easier to purchase than are tablets of prescription drugs like Oxycontin and Percocet. The side effects of these medications include extreme drowsiness and slowed breathing, but the worst side effect, when taking these drugs, is overdose, leading to death.

One might ask, “What does an overdose look like?” A person who has overdosed will look like they are sleeping, will be breathing very slowly, and may not respond to you when you speak to them or touch them. They may have drug paraphernalia on them – a rubber tourniquet and syringes and needles – or they may not (especially if they are overdosing on opioids, which may have even been legally prescribed to them by their health care provider). Of course, there are other health conditions that can also look like an overdose, and you might not be able to tell the difference.

So, what can you do? A major part of this concept of harm reduction involves the use of the drug naloxone (Narcan). While naloxone has been around for several decades, it was typically only used in hospital settings to reverse overdoses. But, we are in a crisis situation now, with some areas reporting 30 overdose deaths per day! Naloxone is a very easy drug for anyone to use and is now available in many states without a prescription. It comes as an injectable medication or one that is sprayed into the nose and, these days, it is being carried by many police and fire personnel as standard procedure.

The idea of asking a non-health care type to take care of an overdose victim can be frightening and leave that person wondering, “What if I don’t give the treatment correctly?” It will still be better than doing nothing – if you don’t give any treatment, the person most surely will die, so that might make the decision a bit easier. If you at least attempt to treat, you will have given that person a chance to survive. One can only get sober if still alive. And giving the medication is not complicated at all. The other issue people (including health care providers) worry about is, “What if this is isn’t a drug overdose but something else?” The great thing about naloxone is that, if one is in the process of overdosing on opioids, it can stop it cold. The other great thing about it is that, if the person you suspect is overdosing is not, the naloxone will not harm her or him. So, you give the naloxone and call 911 and, once the victim is taken to the hospital, you’re done.

Most states allow purchasers to buy naloxone without a prescription and some chain pharmacies even offer a discount. The instructions for giving naloxone are on the package. In some states like New York, where I live, you can go to a syringe exchange program and they will provide you with a free kit and training. Most states allow lay persons to administer naloxone, and those who choose to save a life, are protected by Good Samaritan laws.

So, even if you, in general, have mixed feelings about drug addicts, remember that some of our most beloved celebrities and entertainers struggled with drug addiction – Johnny Cash and Elvis Presley, among many others. We are all better off because they went on living as long as they did. You may be saving the life of a loved one, a stranger, or the next big star. In any case, you may be the one to give that struggling addict their last chance to finally recover. I urge you to at least consider it. If it were your child, spouse or friend, I’m sure you would want them to live, and get a chance to change.

About Norma Stephens Hannigan

Dr. Norma Stephens Hannigan is a Doctor of Nursing Practice who teaches at the Hunter-Bellevue School of Nursing in New York. Dr. Norma has treated many truck drivers at the various clinics she has worked in over the years. She currently writes for 10-4 from her home in Newburgh, New York.

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